September 16, 2013
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BLOG: Glued IOL live surgery — Surgical rendezvous in Malaysia

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Read more blog posts from Priya Narang, MS

Apart from the tagline of tourism “Malaysia – Truly Asia,” the country had much more to offer, including an everlasting experience of performing a challenging secondary intraocular lens implant in a young myopic patient.

The conference was conducted at Tun Hussein Onn National Eye Hospital in alliance with Asian Ophthalmology by Sarbjit Singh, MBBS, DOMS, and Sharon Dhillon. It had an august presence of distinguished speakers from across the continent.

The patient was a young male who was rendered aphakic since childhood following bilateral cataract surgery. The axial length was 27 mm and the IOL power was 12 D. The anterior chamber was deep with horizontal corneal diameter about 13.5 mm and vertical diameter of 12 mm. The case definitely posed a challenge as it was a big eye and it called for certain variations apart from a routine surgical procedure of glued intrascleral fixation technique.

CUSTOMISED VARIATIONS:

1. Vertical glued IOL – The limitation of glued IOL surgery is that no special IOLs are designed (e.g. longer haptics) for this technique. In the surgical scenario, whenever a surgeon comes across a big eye with a larger corneal diameter, that limitation is stretched to its maximum. The patient scheduled for live surgery had a horizontal diameter of 13.5mm. Fashioning of scleral flaps at the 3 o’clock and 9 o’clock position would unduly stretch the haptics. Therefore, vertical glued IOL was planned for this case with the fashioning of flaps at 12 o’clock and 6 o’clock, with the surgeon sitting temporally. This indirectly reflected in more haptic externalization and proper tucking of the haptics.

2. Sclerotomy – In a glued IOL surgery, sclerotomy is made with a 20-gauge needle approximately 1.5mm from the limbus. But in patients with deep anterior chamber, sclerotomy is made about 2mm from the limbus with direction of the needle being more vertical so the needle passes behind the iris tissue. This variation was adopted in the live surgery as the patient was highly myopic with deep anterior chamber.

Apart from these two important variations, there were not any other major changes in the routinely planned glued IOL surgery. The video posted showcases the procedure.

 All’s well that ends well.